Appendiceal Perforation as a Potential Indicator of Healthcare Disparities Between Thai and Non-Thai Populations
A Nationwide Study of Public Hospitals in Thailand
Bibliographic Data
| ID | 24218204 |
|---|---|
| Authors | Wilailak Saengsri (0009-0006-1526-0536), Rapeepong Suphanchaimat (0000-0002-3664-9050), Jomkwan Yothasamut (0000-0001-6101-1756), Chutima Akaleephan, Nicole Huang (0000-0002-6629-1176) |
| Year | 2026 |
| Publication date | 2026-09-29 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Journal of Racial and Ethnic Health Disparities (JOURNAL) |
| Journal identifiers | ISSN: 2196-8837 • E-ISSN: 2197-3792 |
| Publisher | Springer Science and Business Media LLC (PUBLISHER) |
| DOI | 10.1007/s40615-026-03201-w |
| PMID | 42809206 |
| OpenAlex | W7214785038 |
| Language | EN |
| References cited | 37 |
This study examines disparities in appendiceal perforation between Thai nationals and non-Thai populations treated at Ministry of Public Health (MOPH) hospitals in Thailand, using perforation rates as a potential proxy for delayed access to emergency surgical care. We conducted a nationwide, facility-based cross-sectional analysis of 365,581 patients treated for acute appendicitis at 943 hospitals in Thailand between 2018 and 2022. Multivariable logistic regression models were estimated and reported as Average Marginal Effects (AMEs) with Generalized Estimating Equations (GEE) used as a sensitivity analysis. Thai nationals comprised 96% of cases. Non-Thai groups, including Burmese, Cambodian, Laotian, and stateless people had a substantially higher rate of out-of-pocket (OOP) payment. The overall perforation rate was 8.9%, varying by nationality / legal status from 7.6% among Burmese patients to 12.1% among Laotian patients. In adjusted analyses, Laotian and stateless individuals had higher probabilities of perforation compared with Thai nationals (AME: 1.7%, 95% CI: 0.3%, 3.1% and 3.1%, 95% CI: 1.5%, 4.6%, respectively), whereas Burmese and Cambodian patients had lower or similar probabilities. Older age, male sex, comorbidities, OOP payment, and treatment at higher-level hospitals were also associated with higher perforation risk. Although a test of the nationality/legal status and payment status interaction was not statistically significant ( p = 0.225), exploratory stratified analyses revealed higher probabilities of perforation among OOP-paid Laotian (AME: 4.2%, 95% CI: 2.3%, 6.0%), Cambodian (AME: 2.0%, 95% CI: 0.3%, 3.6%), and stateless patients (AME: 2.2%, 95% CI: 0.4%, 4.0%). While Thailand’s health insurance framework promotes equity in emergency surgical care, outreach to specific vulnerable populations may help further reduce potential disparities in timely access.
Acute appendicitis · appendiceal perforation · ethnic minority health · health care disparities · Health insurance · immigrant health · out-of-pocket costs · stateless persons · Thailand · Appendicitis Diagnosis and Management · Emergency and Acute Care Studies · Healthcare Systems and Reforms
A Scoping Review of Immigrant Experience of Health Care Access Barriers in Canada
Sex differences in pain
The influence of education on health
Understanding the Problem of Access to Public Health Insurance Schemes among Cross-Border Migrants in Thailand through Systems Thinking
Barriers to Health Care for Burmese Migrants in Phang Nga Province, Thailand
Socioeconomic inequalities in health outcomes among Thai older population in the era of Universal Health Coverage
Has universal health insurance reduced socioeconomic inequalities in urban and rural health service use in Thailand
Health insurance for people with citizenship problems in Thailand
Explanation of inequality in utilization of ambulatory care before and after universal health insurance in Thailand
Cross-border mobility and social networks
The poor pay more
| Highly cited | No |
|---|